Inside the HRT Boom

HRT (Hormone Replacement Therapy) clinics for both men and women have sprung up and evolved into a multibillion dollar industry.  Business analysts estimate HRT at $39.6 Billion dollars and growing, providing a lucrative business target. In a world looking for quick fixes and instant answers, HRT can be a powerful - if sometimes misused - treatment.  It is not, by itself, a complete solution.   Consider that testosterone use alone had a 6-fold increase over a 10 year span - from 0.52% use to 3.2% use in the US.  But this only accounts for the traditional physician based use, with patients reporting through their insurance companies.  I fear that testosterone use - and abuse - is far greater.    

Testosterone (and other HRT protocols) are an important and effective treatment when used appropriately.  Low testosterone must be investigated.  It can and does put brain and heart health and wellbeing at risk.

The more ‘legitimate’ HRT clinics will often do lab work to measure hormone levels, metabolic panels and more.  They combine these results with a somewhat indiscriminate use of patient intake forms.  Too many people can now guess what to say in their health history, or take a quick trip over to Reddit for the “right answers” that will allow a patient to meet the guidelines for prescriptions.   Testosterone, DHEA and more dangerously, 17-alpha alkylated compounds, are then prescribed.   Many of these HRT physicians call themselves ‘Functional Medicine Physicians’ or ‘Integrative Physicians’.  While there are actual accreditation paths to qualify as a “Functional Medicine Physician”,  many doctors overlook this process and just claim the title. 

There are four major questions I have about the freewheeling use of testosterone today: 
  1. It is essential to look for the “WHY” - the underlying physical and mental conditions - before jumping in to HRT use.  Without actively looking for the why, we move forward without the necessary consideration of other downstream or neural network effects.  This becomes a potentially dangerous practice.  True functional or integrative practitioners know this.
  2. HRT Clinics are, by definition, offering a ‘one solution fits all’ program.  How are using hormones as hacks any different from allopathic medicine doling out prescriptions?  Years ago, medical science was limited by what was known and available to us.  We’ve grown our knowledge and resources exponentially, and no longer have to settle for addressing a symptom because we can’t find a root cause.  That’s lazy medicine, but it’s reinforced by the public demand for fast easy answers.  We are complex beings, and effective long term solutions are rarely fast and easy, but they are available to those who want real answers.   We know that the body and brain are in constant communication, orchestrating our health, behaviors and emotions.  Let’s do the work. 
  3. Hormones will make you feel good and look good for a time.  They may also be masking other issues, allowing us to delay other treatments.  But is the “Exit Plan” considered? How and when does a patient stop? Most patients are not told about the necessary end date for treatment, or given a plan for ‘cycling’ hormone use.  And if we are cycling, with what that doesn’t further shut the body down?   Are we trading in our long term health for a quick boost?  Real health optimization takes work on several fronts - physical, mental, environmental and behavioral.  This is the key to truly looking and feeling good for a lifetime. 
  4. We’ve seen a massive influx of young men under age 25 seeking accelerated aesthetic improvements through weight training and AAS (Androgenic Anabolic Steroids). This group is in fact being targeted online by some predatory HRT clinics, either intentionally or through algorithms that see young men at the highest click rate.  The risks are high given that brain development continues through age 25 in men - an often overlooked issue.  This creates the potential for neurotoxicity, which can result in long term and permanent brain damage. 

Please understand these four things: 

  1. Testosterone (and other HRT protocols) are an important and effective treatment when used appropriately.  Low testosterone must be investigated.  It can and does put brain and heart health and wellbeing at risk. 
  2. All systems must be examined to get to the “WHY”- the underlying issues at hand. Jumping too quickly to HRT ignores the related conditions that must also be addressed. 
  3. Non chemical means are critical.  Reducing stress and lowering cortisol, which eats up your testosterone stores, is an essential part of an effective program.  Then, improving sleep quality using a variety of techniques including light, exercise and nasal breathing, will all increase testosterone naturally. 
  4. Without fail, measure constantly (at least quarterly) to stay within physiological dosage range.  Too much testosterone will cause kidney, heart, and brain damage.  With very rare exceptions, testosterone should never be used under the age of 25.  This can interfere with development and create significant negative effects on brain and body.   
A true Integrative Medical approach gets at the underlying causes and considers brain, body, environment and lifestyle before, during and after use of HRT.   Anything less is irresponsible, even when the patient ‘demands it’ after visiting a website or podcast selling the wonders of HRT.  In other words, do it right or don’t do it at all.